Adenocarcinoma arising in a heterotopic pancreas (Heinrich type III): a case report

<p>Abstract</p> <p>Introduction</p> <p>Heterotopic pancreatic cancer in the duodenum is a very rare disease. Only twelve cases have been reported worldwide to date. We report a rare case of malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum with long-term survival of the patient, and review the 12 cases in the literature.</p> <p>Case presentation</p> <p>A 75-year-old Japanese man was admitted to our hospital complaining of nausea and vomiting. Endoscopy and upper gastrointestinal contrast study showed marked duodenal stenosis. A pylorus-preserving pancreaticoduodenectomy was performed. Histopathological examination of the surgically resected specimen showed malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 30. He is well and shows no signs of recurrence at the time of writing, six years after the surgery.</p> <p>Conclusion</p> <p>Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated.</p

The application of methylation specific electrophoresis (MSE) to DNA methylation analysis of the 5' CpG island of mucin in cancer cells

<p>Abstract</p> <p>Background</p> <p>Methylation of CpG sites in genomic DNA plays an important role in gene regulation and especially in gene silencing. We have reported mechanisms of epigenetic regulation for expression of mucins, which are markers of malignancy potential and early detection of human neoplasms. Epigenetic changes in promoter regions appear to be the first step in expression of mucins. Thus, detection of promoter methylation status is important for early diagnosis of cancer, monitoring of tumor behavior, and evaluating the response of tumors to targeted therapy. However, conventional analytical methods for DNA methylation require a large amount of DNA and have low sensitivity.</p> <p>Methods</p> <p>Here, we report a modified version of the bisulfite-DGGE (denaturing gradient gel electrophoresis) using a nested PCR approach. We designated this method as methylation specific electrophoresis (MSE). The MSE method is comprised of the following steps: (a) bisulfite treatment of genomic DNA, (b) amplification of the target DNA by a nested PCR approach and (c) applying to DGGE. To examine whether the MSE method is able to analyze DNA methylation of mucin genes in various samples, we apply it to DNA obtained from state cell lines, ethanol-fixed colonic crypts and human pancreatic juices.</p> <p>Result</p> <p>The MSE method greatly decreases the amount of input DNA. The lower detection limit for distinguishing different methylation status is < 0.1% and the detectable minimum amount of DNA is 20 pg, which can be obtained from only a few cells. We also show that MSE can be used for analysis of challenging samples such as human isolated colonic crypts or human pancreatic juices, from which only a small amount of DNA can be extracted.</p> <p>Conclusions</p> <p>The MSE method can provide a qualitative information of methylated sequence profile. The MSE method allows sensitive and specific analysis of the DNA methylation pattern of almost any block of multiple CpG sites. The MSE method can be applied to analysis of DNA methylation status in many different clinical samples, and this may facilitate identification of new risk markers.</p

Relationship Between Liver Fibrosis Noninvasively Measured by Fibro Scan and Blood Test

Recently, Fibro scan was developed as a non-invasive device for measuring liver fibrosis. Progression of liver fibrosis has been reported to increase the measurement value (elasticity). We have performed the Fibro scan for liver diseases.[ ;normal liver (n=33), hepatitis C (n=156), hepatitis B(n=36), non-alcoholic fatty liver disease (n=24), auto immune hepatitis (n=9), primary biliary cirrhosis (n=10), alcoholic liver disease (n=7), acute hepatitis (n=3), other liver disease (n=14), recipient of living donor liver transplantation (n=11)] Elasticity, blood test, and indirect fibrosis diagnostic score were comparatively investigated. In the hepatitis C group, the mean value for elasticity was 14.7±12.0 kPa. Elasticity was found to be significantly correlated with the hepatobiliary enzymes, fibrosis markers and indirect fibrosis diagnostic score. When elasticity was divided into ≧14.6kPa(liver cirrhosis) and<14.6kPa(non liver cirrhosis) groups for the investigation, liver inflammation and fibrosis markers were correlated in the progress of fibrosis in non liver cirrhosis, and it could be speculated that if liver cirrhosis is reached, progression of fibrosis reflects decreased liver function